Peritoneal Dialysis in Renal Replacement Therapy for Patients with Acute Kidney Injury

Abstract

Peritoneal dialysis (PD) was the first modality used for renal replacement therapy (RRT) of patients with acute kidney injury (AKI) because of its inherent advantages as compared to Hemodialysis. It provides the nephrologist with nonvascular alternative for renal replacement therapy. It is an inexpensive modality in developing countries and does not require highly trained staff or a complex apparatus. Systemic anticoagulation is not needed, and it can be easily initiated. It can be used as continuous or intermittent procedure and, due to slow fluid and solute removal, helps maintain hemodynamic stability especially in patients admitted to the intensive care unit. PD has been successfully used in AKI involving patients with hemodynamic instability, those at risk of bleeding, and infants and children with AKI or circulatory failure. Newer continuous renal replacement therapies (CRRTs) are being increasingly used in renal replacement therapy of AKI with less use of PD. Results of studies comparing newer modalities of CRRT versus acute peritoneal dialysis have been conflicting. PD is the modality of choice in renal replacement therapy in pediatric patients and in patients with AKI in developing countries.

High-Volume Peritoneal Dialysis in Acute Kidney Injury

“…Our results are similar to the results of previous studies that showed that PD clearance was limited by dialysate flow, membrane permeability, and area (6)(7)(8)(9)(10)(11)(20)(21)(22)(23)(24)(25)(31)(32)(33)(34)(35). A 2-L exchange with a dwell time of 30 minutes can achieve dialysate saturation of around 50%.…”

Peritoneal Dialysis for Acute Kidney Injury

“…(90). Glucose absorption occurs across the peritoneal membrane continuously, and is enhanced by small exchange volumes that are typically used for acute PD and which result in a gradually diminished osmolar gradient and less efficient ultrafiltration.…”

Diabetic ketoacidosis with acute kidney injury in prepubertal children: a report on two cases

“…Peritoneal dialysis is an advantageous modality for renal replacement therapy (RRT) in AKI. 23 Our patients had several indications for dialysis including oliguria/anuria, intractable metabolic acidosis, fluid overload, and hypertension. We used the pediatric RIFLE (pRIFLE) classification to asses for AKI and to evaluate kidney injury on admission and at subsequent times.…”

“…14 The AKI remains a significant contributor to the morbidity and mortality of critically ill infants and children and occurs more frequently in intensive care units (ICUs), especially in patients with multi-system organ failure. 8,23 The etiology of AKI associated with DKA is probably multifactorial, most likely due to hypovolemia and hypotension. 6 AKI is frequently associated with severe DKA on ICU admission.…”